For many years, the narrative surrounding obesity in the United States has been one of relentless increase. From the inaugural year of Gallup’s National Health and Well-Being Index, the proportion of U.S. adults reporting obesity steadily climbed, escalating from 25.5 percent in 2008 to a peak of 39.9 percent in 2022. This trajectory underscored an epidemic that has expanded dramatically over decades, with estimated obesity prevalence tripling in the last 60 years.
Despite considerable efforts, including an annual $33 billion expenditure by Americans on weight loss products and services, alongside national public health campaigns such as first lady Michelle Obama’s Let’s Move initiative, little seemed to stem the tide. Many medical professionals and patients alike began to harbor concerns that the persistent rise in obesity might be biologically unavoidable, notwithstanding the severe health risks it entails.
However, a significant shift is now emerging in the data, signaling a potential turning point in one of the most pressing health crises of our era. The latest findings from Gallup’s survey indicate that self-reported obesity has begun to recede, dropping by nearly three percentage points to 37 percent this year. This represents a statistically meaningful decrease, translating to an estimated 7.6 million fewer obese adults compared to three years ago.
This unprecedented reversal appears to be largely attributable to the escalating use of glucagon-like peptide-1 (GLP-1) agonists, a class of medications widely known by brand names such as Ozempic and Wegovy. These drugs, originally developed for diabetes management, gained approval for obesity treatment in the U.S. market in 2021, and their impact is rapidly becoming evident across the nation.
The adoption of these powerful medications has seen a remarkable surge. The Gallup survey reveals that the number of Americans utilizing drugs like semaglutide or tirzepatide for weight loss has more than doubled over the past eighteen months. Specifically, 12.4 percent of respondents reported taking these drugs, a notable increase from 5.8 percent in February 2024, when Gallup initiated its measurement.
GLP-1s represent a watershed moment in the enduring American struggle against obesity and its associated diseases. These conditions have stubbornly and consistently risen through various dietary trends and public health interventions over decades. Intriguingly, while the obesity rate sees a decline, the same index noted the highest ever rate of diabetes, at 13.8 percent, among respondents asked if they had been diagnosed by a doctor or nurse.
The survey offers compelling evidence that a shift in obesity rates may be underway, albeit gradually. Post-market introduction of these medications, declines in obesity rates have been more pronounced among individuals aged 40 to 64. This trend aligns with a higher reported reliance on GLP-1 medications within this demographic.
For instance, medication usage is highest among those aged 50 to 64, a cohort that experienced a 5.0-point reduction in obesity rates, bringing their total to 42.8 percent. Furthermore, the survey identified that more women are taking these drugs, correlating with greater weight loss when compared to men.
These contemporary treatments exert their influence by acting on both the brain and the body’s hormonal systems, effectively suppressing hunger and decelerating digestion. They operate by attenuating hunger signals in the brain, slowing gastric emptying, and enhancing post-meal insulin signaling. Unlike older weight-loss medications that offered only marginal body weight reductions and often led to quick regain, GLP-1 agonists target the fundamental biology that makes sustained weight loss challenging.
In extensive randomized trials, semaglutide at a 2.4 mg dosage, the active component in drugs like Ozempic, demonstrated an approximate 15 percent average weight loss over 68 weeks when combined with basic lifestyle support. Other formulations, at higher doses, have achieved as much as a 20 percent reduction. Such substantial efficacy means that even if a moderate segment of the adult population uses them, a measurable impact on population-level data becomes observable.
While much public discourse surrounding these drugs has centered on weight and aesthetic changes, their health benefits extend considerably further. In 2024, the Food and Drug Administration (FDA) expanded the approved indications for the GLP-1 drug Wegovy to include cardiovascular risk reduction. This decision was based on pivotal trial results demonstrating fewer heart attacks, strokes, and cardiovascular deaths in adults with obesity or overweight conditions and established heart disease.
This FDA action also paves the way for Medicare coverage for patients with cardiovascular disease, signaling an early but crucial step toward expanding access beyond individuals with robust insurance. If the national obesity curve continues its downward trajectory, the benefits would be immense, as obesity amplifies the risk across nearly every major cause of death.
Even modest, sustained decreases in prevalence could translate into millions fewer individuals contending with diabetes, heart disease, sleep apnea, and debilitating joint disease. Concurrently, billions of dollars in medical costs could be saved over time, a significant relief considering the Centers for Disease Control and Prevention (CDC) estimates direct medical spending linked to obesity to be roughly $173 billion.
Despite their transformative potential, access to these drugs remains a significant hurdle. Dr. Fatima Cody Stanford, a Harvard University obesity specialist, warns that while the observed correlation in obesity reduction likely occurred among those with excellent insurance coverage, this may not last. She notes that many private insurers, including those covering most of her patients, are planning to cease coverage of GLP-1 medications as of next year.
Without insurance coverage, patients typically face out-of-pocket costs of approximately $500 per month for these injections. While pharmaceutical companies are actively developing potentially less expensive pill versions, Dr. Stanford cautions that these treatments will likely still be financially prohibitive for many, thereby exacerbating existing health disparities, as obesity itself is frequently linked to lower socioeconomic status.
The distribution of GLP-1 prescription rates across the U.S. also reveals significant geographic unevenness, according to a 2024 report by GLP-1 Newsroom, which analyzed insurance claims data from Purple Lab. This report, covering both commercial and government insurers, did not include individuals who paid cash, used telehealth providers, opted for compounded versions, or were uninsured, suggesting actual numbers are likely higher.
The highest GLP-1 usage rates, exceeding 15 percent of the state’s population, were concentrated in the South, Midwest, and Appalachia. States like West Virginia (24 percent), Kentucky (22 percent), and Louisiana (20 percent) topped this list. This geographic pattern is likely a reflection of these regions’ higher pre-existing rates of obesity and diabetes.
Conversely, states predominantly located in coastal and Western regions exhibited the lowest usage rates. Hawaii, for example, registered the lowest overall prescriptions at 5 percent, followed by states like Rhode Island (7.5 percent) and Oregon (8 percent). This regional divergence underscores the complex interplay of access, prevalence, and healthcare infrastructure.
Further analysis of obesity rates by state from the Trust for America’s Health, based on 2024 CDC data, shows a strong correlation with GLP-1 usage. The ten U.S. states with the highest adult obesity rates, all situated in the South or Midwest, largely overlap with high GLP-1 prescription rates. For instance, West Virginia recorded an adult obesity rate of 41.4 percent, while Mississippi stood at 40.4 percent.
Notably, in nine of these top ten states for obesity, at least 15 percent of the population holds GLP-1 prescriptions. Overall, 19 states registered adult obesity rates of at least 35 percent, a decrease from 23 states the previous year, marking the first time no state had an adult obesity rate below 25 percent. States with the lowest obesity rates included the District of Columbia (25.5 percent) and Colorado (25 percent).
Among the newer generation of treatments, tirzepatide, marketed as Mounjaro and Zepbound, is gaining prominence for its distinctive mechanism. This medication is lauded for its two-part approach, activating both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) hormone systems simultaneously. This dual action is designed to manage both appetite and the body’s energy utilization more comprehensively than traditional methods.
Results from tirzepatide usage often manifest rapidly, with many patients observing weight changes within weeks when coupled with healthy eating and physical activity. Its convenient weekly injection schedule allows for easy integration into daily life, requiring only an initial clinic visit. Beyond weight reduction, it is associated with broader health improvements, including reduced risks of high blood pressure, stroke, and diabetes.
The potential applications of GLP-1 drugs are also rapidly expanding beyond their current primary indications. Dr. Brett Osborn, a Florida neurologist and longevity expert, anticipates a future where these agents are increasingly prescribed not just for type 2 diabetes or obesity, but also for preventing vascular disease, tempering drinking habits, addressing gambling addiction, slowing cognitive decline, and even as an adjunct to chemotherapy treatments for cancer.
Indeed, the current generation of GLP-1s, effective as they are, may represent the least advanced and most expensive versions we will ever encounter. Pharmaceutical companies are actively developing oral forms of these medications, which promise to simplify dosing and mitigate needle phobia, a condition affecting as much as 20 percent of the American public.
While there may be an inherent discomfort with the notion of primarily addressing obesity through pharmaceutical intervention, especially when considering the enduring calls for healthier food systems and increased physical activity, it is crucial to contextualize these efforts. The contemporary environment is demonstrably “obesogenic,” meaning it is heavily structured to promote weight gain.
As the Pew Research Center survey highlights, approximately two-thirds of Americans believe that willpower alone is typically insufficient for most individuals trying to lose weight and maintain it. In this challenging landscape, GLP-1 drugs present a potent opportunity to recalibrate the scales, offering a scientifically grounded means to counter biological predispositions and environmental pressures.
This emerging data marks a hopeful chapter in the enduring struggle against obesity, signifying that the years of seemingly insurmountable upward trends may finally be giving way to a new era of progress. The profound impact of GLP-1 medications extends beyond individual weight loss, promising widespread public health benefits that could fundamentally reshape the landscape of chronic disease. As innovations continue and access expands, the potential for a healthier future appears increasingly within reach, transforming what once seemed an intractable challenge into a navigable path towards collective well-being.
